殷恒讳 招　扬 姚　陈 王　冕 常光其中山大学附属第一医院血管外科，广州 510080



限制性裸支架在预防主动脉夹层腔内修复术后支架远端再撕裂中的应用

殷恒讳 招扬 姚陈 王冕 常光其*
中山大学附属第一医院血管外科，广州 510080

摘要：目的研究降主动脉限制性裸支架（restrictive bare stent，RBS）对支架远端再撕裂（stent graft-induced distal re-dissection，SIDR）的预防作用。方法对2011-01—2014-12中山大学附属第一医院血管外科接受主动脉扩张性疾病腔内修复术中植入降主动脉RBS的患者资料进行回顾性分析。结果共45例患者纳入研究，男性41例（41/45，91.1%），女性4例（4/45，8.9%），年龄为33～73岁，平均年龄为（51.16±9.75）岁。全组45例患者手术均获得成功，其中10例结合烟囱技术（10/45，22.2%）、6例结合人工血管旁路术（6/45，13.3%）重建弓上分支。术后即时Ⅰ型内漏发生率为15.6%（7/45）。随访期间无患者死亡，CT血管造影（Computed tomographic angiography，CTA）复查提示无患者发生SIDR，支架范围内真腔较术前均明显扩张，主动脉重塑满意。结论在应用腔内修复术治疗主动脉夹层（aortic dissection，AD）时联合RBS植入术，能够有效地预防SIDR发生，并且具有良好的短-中期疗效。

关键词：主动脉夹层；主动脉腔内修复术；支架远端再撕裂；限制性裸支架Abstract: ObjectiveTo describe the use of restrictive bare stent (RBS) preventing distal stent graft-induced re-dissection (SIDR) in endovascular repair of aortic dissections. MethodPatients with aortic dissection treated in our center between January 2011 to December 2014 were retrospectively collected and analyzed. The clinical manifestations and managements were collected. Computed tomographic angiography (CTA) would be used for diagnosis and follow-up. ResultFourty-five patients with aortic dissection and restrictive bare stent implantation were included, contained fortyone men (41/45, 91.1%) and four women (4/45, 8.9%), with the average age of 51.16±9.75 years old (range, 33-73 years old). Successful stent deployment and sealing of the entry tear was achieved in all patients. Ten cases (10/45, 22.2%) hadbook=7,ebook=11performed chimney technique and six cases (6/45, 13.3%) had performed artificial blood vessel bypass adjunctively. Immediate post-operative type I endoleak rate was 15.6% (7/45). No patient were lost or had distal SIDR during hospitalization and follow-up. No stent complications, such as angulation, dislodgment or branch obstruction, had been observed. The remodel of aorta within the range of stents was approving in all cases. ConclusionsAdjunctive use of restrictive bare stent when treating aortic dissection is feasible and safe. It provided good prevention of distal SIDR and admired short- to mid-term outcomes.

Restrictive bare stent preventing distal stent graft-induced re-dissection in endovascular repair of aortic dissection

YIN Heng-huiZHAO YangYAO ChengWANG MianCHANG Guang-qi*
Department of Vascular Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China

Key words:aortic dissection; thoracic endovascular aortic repair; distal stent graft-induced distal re-dissection; restrictive bare stent

AD是一种极为凶险的致死性疾病。自1999年主动脉腔内修复术（thoracic endovascular aortic repair，TEVAR）治疗AD的技术兴起[1,2]并且不断发展，越来越多患者的预后得到改善。但是，TEVAR的特殊并发症也获得更多关注，例如各型内漏、逆行撕裂A型夹层、支架移位及支架扭曲等。其中，TEVAR术后SIDR是严重的并发症之一。有研究表明[3,4]，34.8%TEVAR术后再撕裂定位于支架远端，即远端SIDR，死亡率达25%。故在行TEVAR时避免远端SIDR的发生，是进一步改善AD患者预后的重要课题。……